Rochester Hospitals Collaborate to Reduce Medicaid Costs

Rochester’s health systems are leading a consortium that includes more than 200 community-based organizations throughout the region that will work together to redesign the way that health care is delivered to the region’s 320,000 Medicaid recipients.The goal is to reduce avoidable hospital admissions by 25 percent over five years by keeping patients healthier. 

The consortium, called the Finger Lakes Performing Provider System, was established by leaders from UR Medicine, Rochester General Health System, and Unity Health System.  They are seeking funding from the state’s Delivery System Reform Incentive Payment program, or DSRIP, which has received an $8 billion waiver from the Centers for Medicare and Medicaid Services to fund efforts across New York aimed at improving quality and driving down costs.

“For decades, the Rochester region has been recognized nationally for its innovative and collaborative approach to quality healthcare,” said Mark C. Clement, president and CEO of the Rochester General Health System.  “We are proud to co-lead this planning grant aimed at fundamentally changing the way healthcare is provided to Medicaid patients in our region.  With this grant, and with the collaboration of literally hundreds of healthcare providers in our 14-county area, we expect to refine delivery systems that not only continue to control cost, but more importantly improve quality and access for patients.”

In addition to the hospitals, the consortium includes health planning organizations, physicians, nursing homes, behavioral health and substance abuse programs, social service agencies, and other programs that provide services across the 14-county area around Rochester. Representatives from the organizations have been meeting since April to develop a needs assessment and to consider projects that the consortium should undertake to reduce avoidable hospital admissions.  Potential projects include:

• Creating additional primary care services and establishing “medical homes” for Medicaid patients, who often rely on hospital emergency departments for health care because they don’t have a doctor.
• Intervening immediately when Medicaid patients visit the emergency department because they don’t have a primary care provider.  New triage systems would be set up to immediately assign those patients a primary care provider.
• Co-locating behavioral health and primary care services in the same locations to simplify referrals.
• Expanding transportation options so patients don’t miss routine medical appointments, which can cause conditions such as diabetes or asthma to worsen, resulting in hospitalization.
• Expanding transitional housing and care options, so patients discharged from a hospital can receive proper care and avoid readmission.

“Rethinking  the way we deliver services through the Medicaid program is an essential step toward bending the cost curve of health care,” said Steven I. Goldstein, president and CEO of Strong Memorial and Highland hospitals.  “In New York, like in other states, our challenge is to implement strategies that achieve lower costs by keeping people healthier and avoiding hospitalizations.”

The Finger Lakes Health Systems Agency will work with the consortium’s other stakeholders over the next two months to complete a needs assessment that will inform the final project selection.   A final grant application will be submitted to the state’s DSRIP program in December.  If funded, teams from across the consortium would begin work in early 2015 to launch the projects and measure their effectiveness.

“America’s health care industry is going through fundamental change,” said Warren Hern, president and CEO of Unity Health System. “We’re pleased to be part of the team that will keep our community healthier and embrace the new model of health care delivery?sharply focused on improving health care quality, affordability and access for our underserved patients.”

In 2011, New York Gov. Andrew Cuomo established the state’s Medicaid Redesign Team, a group of health care experts and stakeholders charged with redesigning the state’s Medicaid program, whose costs exceed $50 billion annually.   The Medicaid Redesign Team is administering the DSRIP grant process that will fund regional efforts across the state to improve quality and outcomes while reducing the state’s Medicaid costs.